Johnson & Johnson paints a bleak picture of the doctor/patient relationship

THERE is no mention of patients in a Johnson & Johnson document quoted in a Federal Court this week.

The document, with a section headed “The Practice-Driven Physician”, was written in May, 2010. It was tendered to Federal Court Justice Anna Katzmann on the first day of a landmark legal class action by more than 700 women who have been implanted with Johnson & Johnson pelvic mesh devices to treat incontinence and prolapse. It is expected to last for six months.

Even though we were only treated to short snippets from what is clearly a lengthy document, it was an eye-opener.    

On page 317 Johnson & Johnson outlined a portrait of a “practice-driven physician” – the kind of doctor the company appears to have pitched its pelvic mesh devices at.

This J & J-targeted doctor is impressed by the speed he/she can put mesh devices in women patients, is “highly motivated to drive a successful practice” and keen on “growing reputation and revenue”.

Page 315 of the Johnson & Johnson document carries a script of what the “practice-driven physician” sounds like when the advantages of J & J mesh devices are presented to him. And let’s drop the pretence about gender here.

The vast majority of doctors I’ve come across while reporting on transvaginal mesh for the past three years have been men, and the J & J script of the “practice-driven physician” shows the company imagines a doctor impressed by things that come under the heading of “big boys’ toys”.

Here is our “practice-driven physician” talking in the J & J script. He says he’s “just got back from a week in St Moritz – fabulous ski conditions. I picked up the Lamborghini on Friday. An amazing machine”.

Dr Kildare, he ain’t.

Two women were standing in the court on Tuesday while Johnson & Johnson’s portrait of an ideal mesh doctor was read out. The women can’t sit for any length of time after mesh surgery a number of years ago. They were visibly distressed, shocked and horrified by what they were hearing.

The “practice-driven physician” in J & J’s sights loves the idea he can implant a woman with a mesh device in just eight minutes.

“That makes four before lunch. That works for me,” Johnson & Johnson pictures him saying.

The imagined doctor is told about a transvaginal mesh device for treating prolapse and he immediately asks: “How is the reimbursement for that procedure?”. He is pleased with the response.

Maybe the Johnson & Johnson document has another section headed “the patient-focused physician” and we just didn’t hear about it. Somehow, I doubt it.

Any romantic ideas you might have about the relationship between doctor and patient are shattered by those excerpts from a device manufacturer, because the patient isn’t mentioned.

The patient, in that equation, is the vehicle by which the doctor can make the money he needs to buy the Lamborghini, and if he can turn over four implants in a morning and the “reimbursement” is good, all the better.

The cold, hard truth is that such doctors exist, along with doctors who pay lip-service to concepts like informed consent.  

It was the women’s barrister, Tony Bannon, SC, who reminded the court that women are part of the equation, annoying as that idea might be for doctors and device manufacturers keen on speed.

Bannon acknowledged mesh device implant surgery can be done quickly, “but one wonders when one looks at the numbers of operations, is there any opportunity for the surgeon or anybody else to inform the patient of the true risks?”

I started writing about transvaginal mesh devices after an anonymous email to the Newcastle Herald office in August, 2014. It was about a woman taking civil action against a gynaecologist after she experienced serious complications following mesh surgery to treat prolapse.

I had never heard of mesh before.

It wasn’t very long before the similarities between reporting on child sexual abuse within institutions, and what happens when things go terribly wrong when women are implanted with transvaginal mesh devices – and particularly devices to treat prolapse after childbirth – were striking.

It wasn’t very long before the similarities between reporting on child sexual abuse within institutions and the implanting of women with transvaginal mesh devices – and particularly devices to treat prolapse after childbirth – were striking.

Both involve abuses of power that take a sexualised form. Both involve lack of consent – in the case of many women patients, it’s being informed of the full suite of risks associated with mesh devices or, in some cases, being told they’re going to be implanted with a device at all. And remember we’re talking about a scenario where women trust that the doctor who introduces a device through their vaginas will do them no harm.

When I first started reporting on child sexual abuse in 2006 the victims would often ring, say their names, and within a few minutes they would be crying. The same occurred from 2014 when women started ringing to say their lives had been destroyed after mesh device implant surgery had gone terribly wrong. Their emotional responses were of being sexually assaulted.

In both cases – child sexual abuse in institutions and the global pelvic mesh scandal – there has been regulatory failure across the board. In both cases the victims were often shamed into silence. Too many people abused as children have blamed themselves. Too many women left with permanent injuries after mesh surgery have been shamed into silence because of their symptoms, and because they blame themselves for being so trusting.

Doctors do not want to hear this, and some will no doubt be angered by the comparison. But the medical industry – for that is what the mesh device scandal exposes – has to face what that Johnson & Johnson document says. Women patients have been reduced to things.